Somalia: CALL FOR EXPRESSION OF INTEREST FOR HEALTH FACILITY ASSESSMENT (HFA) CONSULTANCY BY A NGO/FIRM/INSTITUTION IN SOMALIA

Background and Context The health system in Somalia remains fragmented and service delivery continues to be poorly organized due to lack of qualified staff, poor supervision and coordination, and low coverage of essential lifesaving and high impact interventions. Somalia has some of the worst health and nutritional indicators in the world and is ‘off-track’ to reaching health related MDGs. Health sector services are mainly provided by the private and public sector through a combination of facility and community based delivery mechanisms. Maternal and Child Health (MCH) centers are the main point for public health service delivery in most rural areas. The level and quality of functioning of the MCH centers varies from one district to another depending on the available resources, the existing and capacity of health staff among other things. Additionally, ongoing programmes in support to Health Systems Strengthening (HSS) are not yet adequately addressing the community level, including Health Posts and Community Health Workers and there is little information about services provided at this level. Health Posts constitute the first tier of the Somali health system. According to the EPHS strategy, only functioning Health Posts will be included in the roll-out of the Essential Package of Health Services (EPHS) and up-graded to Primary Health Units.

In 2012 the Somali Health Authorities developed three HSSPs to support the delivery and implementation of the EPHS. The implementation of EPHS continues to be strengthened and rolled out using a phased in approach to newly selected districts to increase coverage and accessibility of essential primary health care services. The Somali Health Authorities in collaboration with WHO, UNFPA and UNICEF plan to undertake an assessment of approximately 820 health facilities (78 hospitals, 304 MCHs and 438 Health Posts) across the three zones (South Central, Puntland and Somaliland) of Somalia. The assessment will be conducted using the standard Service Availability and Readiness Assessment (SARA) methodology.

Justification

Currently, information and evidence on the performance of the health systems to help managers make decisions, plan, implement and monitor health services is very limited or non-existent. The assessment will generate information on selected service delivery indicators at health facilities for evidence-based decision making, and to track and monitor the progress and implementation of the HSSPs.

Objectives of the HFA Specific Objectives: the health facility assessment will generate the following information;

1. General service availability (accessibility of health services): health infrastructure (density of facilities and inpatient beds), core health personnel, and inpatient/outpatient services utilization.
2. General service readiness (capacity of health facilities to provide general health services): presence of infrastructure/amenities, basic equipment, standard precautions for prevention of infections, laboratory diagnostic capacity, and essential medicines.
3. Specific service availability and readiness (proportion of facilities providing specific key health interventions and their capacity to provide these services): availability of guidelines, trained staff, equipment, diagnostics, and medicines and commodities required to provide the service.
4. The status and functionality of support systems (supply chain, supervision, information system, transport/referral, repair/maintenance, community involvement/engagement among others in the facilities).
5. Quality of care using exit interviews with clients/patients as a proxy indicator.

Scope of the Consultancy: While the overall management and technical leadership of the assessment will rest with WHO, a institution/firm/NGO will be subcontracted mainly for the field work (planning, data collection and data management). In order to build capacity and ensure the ownership, the Ministries of Health in the three zones will be fully involved in the design, planning and implementation of the assessment.
To this effect, WHO would like to sub-contract a firm / NGO / institution in Somalia to support and conduct required field work including planning, implementation and quality assurance and control of the health facility assessment. The contracted institution will work closely with Ministries of Health in the three zones. 3.1 Roles and responsibilities of the firm/NGO/institute in collaboration with Ministries of health, will include; A. Recruit and organize survey teams for the three zones; i. define the composition and organisation of the survey teams; ii. develop job descriptions and selection criteria for survey team members; iii. select survey team according to the selection criteria for fieldwork and data management; B. Prepare for fieldwork, and specifically collaborate with WHO survey coordinator to: i. develop fieldwork plan, logistic as well as data collection; ii. develop data entry and management plan; iii. adapt the SARA data collection tools iv. translate the data collection tools into Somali v. organize pilot(field) testing the survey tools; vi. test the data collection tools and provide feedback to the WHO survey coordinator; vii. develop plan for the training of different cadres of survey team; C. Organize training for data collection and management, and in this regard work with WHO survey coordinator to: i. assure the availability of trainers according to the training plan; ii. participate in the training of trainers; iii. organize venue with adequate facilities for training iv. conduct the training of trainees, assuring good quality training; v. conduct training of data collectors D. Conduct fieldwork with special emphasis on: i. identification and documentation of the process for the sampled facilities; ii. arrange and provide the logistics for the fieldwork, including coding of data collection tools, stationary and/or equipment/accessories for data collection, transport and security of the teams; iii. organizing and conduct data collection assuring good quality data and that team members (field coordinators, supervisors(team leaders) and data collectors perform their functions as prescribed in their job description and training provided to them) iv. assuring the safety of filled in data collection tools/equipment and timely dispatch or transmission to the data management team; v. adapting and assuring that SARA guidelines and instructions in the manuals for the fieldwork are followed; E. Manage the data coming from the field, and for that: i. Set up a data management office/room in each zone with required facilities, i.e. shelves for filled in data collection tools, adequate stationary, computers and accessories; ii. Assure the safety of the data management office/room from all aspects (fire, theft etc.); iii. Develop job descriptions for data managers and clerks that are to the satisfaction of the WHO; iv. Select, train and organize data management team (data managers and data coders/clerks) v. Ensure the data managers and clerks are provided the necessary equipment, accessories and stationary; vi. assure the different members of the data management team perform according to the vii. provide clean dataset with dictionary to the data analysis team; viii. Participate and assist in analysis of data and writing the survey report; F. Submit periodic reports, updates and respond to the questions/queries while collecting and managing data; 4.0 Health Facility Assessment Methodology The assessment will use Service Availability and Readiness Assessment (SARA) methodology. It (SARA) covers two aspects of the health facility preparedness—general readiness and preparedness for providing specific services will be measured. In general, the survey will focus on answering the following broad groups of questions, which are critical to the service provision dimension of the country’s health system:

1. What is the availability of different health services in the country? Specifically, what proportions of the different facility types offer specific health services?
2. To what extent are facilities prepared to provide health services? Do facilities have the necessary infrastructure, resources and support systems available? For example, what proportions of facilities have regular electricity? What proportions have regular water supply?
3. To what extent does the service delivery follow generally accepted standards of care? Does the process followed in service delivery meet standards of acceptable quality and content?
4. What support systems like supply chain, supervision, information system, transport/referral, repair/maintenance among others do exist in the facilities?

4.1 Data collection tools The standard SARA questionnaire will be adapted in order to capture information required for the selected indicators included in the EPHS and any other additional indicators that are necessary. Once the questionnaire is finalized, it will be translated into Somali to facilitate the interview process since some of the data collectors and/or respondents may not be conversant in English. The questionnaire will be field-tested and observations arising out of the exercise will be incorporated and will then be finalised. After this, data entry fields shall be created on tablets that shall be used for data collection. Data collection will be through interviews with key informants and verification of reported availability and functioning of essential equipment and supplies, along with observation of availability of medicines and commodities on the day of the visit.

5.0 Deliverables

1. An Inception Report -This shall be prepared and submitted within two weeks after the signing of the contract. The consultant will prepare this after reviewing key technical documents and after discussion with WHO, Ministries of Health, UNICEF, UNFPA and other partners. The inception report shall focus on: the understanding of the Terms of Reference and scope, the relevant methodology to be adopted, the design and key questions, and, the work-plan for the assignment.
2. Adapted final data collection tools in English and Somali languages
3. Adapted training manuals and guidelines for field work
4. Job descriptions for the survey team members-coordinators, team leaders and data collectors, data managers
5. Submit validated and cleaned data for each health facility visited on a daily basis to the data management unit/server
6. Progress periodic reports, briefs and updates on fieldwork- While there is no formal progress report required during the assignment implementation, between inception and Draft report submission, the consultant (s) shall be expected to regularly (bi-weekly) share with the WHO, key emerging issues and trends to avoid surprises or misconceptions by either party.
7. Provide clean dataset ready for analysis.
8. Draft Report This shall be prepared and submitted to WHO towards the end of the assignment. The draft report shall require feedback in form of comments, questions and inputs from WHO, MOH, UNICEF and UNFPA and partners.
9. Final Report – •prepare and submit a final report for the consultancy 6.0 Reporting Reporting shall be directly to WHO while keeping MOH, UNICEF and UNFPA in the loop. 7.0 Timing: The assignment is expected to be completed within a 120-day period, effective from the date a contract is signed. 8.0 Criteria for selection of Firm/NGO/Institution The firm/NGO/Institution will be selected through an open and competitive process by WHO, MOH, UNICEF and UNFPA and will be based on their proven experience, qualifications and ability to deliver a high quality product in a timely and efficient manner. Particular qualifications and experience of the lead consultant team members include: • Post graduate degree in Health related Sciences or subjects (Public health, Epidemiology etc.), and with at least 8 years of relevant experience (leader); • 10 years’ experience in similar survey fieldwork (data collection, validation, entry and analysis) in sub-Saharan Africa; • Recent experience with SARA or Health Facility Assessment methodologies; • Experience in leading teams in field (training, field logistics, human relations, teamwork) • Demonstrable ability and experience in working with MOH, health facilities, communities, National NGO partnership and the team’s capacity to undertake the study or surveys in Somalia before; • Excellent writing and communication skills • Demonstrable analytical skills; • Excellent knowledge of English. A working knowledge of Somali will be an added advantage.

Applications should be made in writing including: • Organization background, portfolio with previous Somali experience • Licence or authorization to operate into Somalia in the relevant field of work shall be produced prior contract signature • CV of experts • Quality or Identity of Somali partners for International Consultancy Firms/Organization and sent to:

WHO Somalia Email: recruitment@nbo.emro.who.int Pre-qualified applicants would be further requested to provide with concept and financial proposal ONLY CANDIDATES UNDER SERIOUS CONSIDERATION WILL BE CONTACTED FOR INTERVIEW